1. Technical Field
The present disclosure generally relates to endoscopic general surgery, and more particularly, to surgical systems, devices, and methods for electrosurgical denervation and endocrine management of the female reproductive organs.
2. Background of Related Art
Electrosurgery is a technique of using alternating current electrical signals, using a carrier frequency in the approximately 200 kHz-3.3 mHz range, in connection with surgical instruments, to cut or coagulate biologic tissue endogenically. This electrosurgical signal can be a sinusoidal waveform operating in a continuous mode at a 100% duty cycle, or pulse modulated at a duty cycle of less than 100%. Typically, electrosurgical signals are operated at 100% duty cycle for maximal cutting effect, and are pulse modulated at duty cycles ranging from 50% to 25% for less aggressive cutting, also referred to as blending, or, at a substantially lower duty cycle of approximately 6%, for coagulating.
The electrosurgical carrier signal can be varied in intensity, and manner of application. Electrosurgical energy may be applied to a patient via electrodes in either a monopolar mode, or a bipolar mode. In monopolar mode, an active electrode is provided by the surgical instrument at the surgical site and a return electrode is positioned elsewhere on the patient (typically buttocks or thigh), such that the electrosurgical signal passes through the patient's body from the surgical site to the return electrode. In bipolar mode, both the active and return electrodes are provided by the instrument positioned at the surgical site and may be effectuated by, for example, both tines of a pair of forceps. In bipolar procedures, the electrosurgical signal passes through the tissue that is held between the electrodes of the instrument. A surgeon's decision to use monopolar or bipolar mode electrosurgery is often based upon various factors, including for example the type of procedure to be performed, or whether the patient is fitted with a metallic prosthesis or cardiac pacemaker.
Premenstrual dysphoric disorder (PMDD) is a severe form of premenstrual syndrome (PMS) that may be diagnosed by observing a pattern of symptoms. According to a report by the Committee on Gynecologic Practice of the American College of Obstetricians and Gynecologists, up to eighty percent of women of reproductive age experience physical changes related to menstruation. Twenty to forty percent of such women experience symptoms of PMS, while two to ten percent report that menstruation causes severe disruption of their daily activities. Menstruation-related physical discomfort, such as dysmenorrhea, may begin with a woman's first menstrual cycle (menarche). Often, this condition is superseded by PMS in late adolescence or by a woman's early twenties. These syndromes generally remain stable over time.
The serotoninergic antidepressants are a first-line treatment for severe PMDD. For example, a daily 20 mg dose of Fluoxetine has been shown to be superior to placebo, whether used only during the post-ovulation (luteal) phase or throughout the full menstrual cycle.
It has been shown that by inducing anovulation and amenorrhea, the use of GnRH agonists, leuprolide, histrelin, and/or goserelin provide significant relief of symptoms in patients without comorbid depression. However, these medications can induce menopausal symptoms such as hot flushes, vaginal dryness, fatigue, irritability, cardiac problems, and osteopenia. In women with a history of PMDD, treatment of induced menopause with estrogen, or with estrogen in combination with progestational agents, can induce recurrent symptoms of PMDD. This finding supports the theory that female gonadal hormones have an etiologic role in PMDD.
In very rare cases of severe PMDD, surgical ovarian removal (oophorectomy) may be considered, because ovary removal has been shown to relieve PMDD symptoms. Endoscopic surgery for the ligation of fallopian tubes and other bodily vessels with the use of radiofrequency energy is well known to the field of gynecology. Such instruments effect sealing of bodily vessels via the application of electrosurgical energy to tissue and are used in resection procedures. In addition, the use of radiofrequency energy for denervation of adrenergic organs, such as the kidneys, is known to the medical art.